Most complications of ERCP in patients with previous Billroth II gastrectomy were caused by bowel perforation while the endoscope was being manipulated through the afferent limb. Such perforations are intraperitoneal and require surgical intervention.

Background: Psoriasis is a chronic inflammatory skin disease with an incompletely understood pathogenesis, partly an immune dysfunction. Immunomodulatory agents like biologics drugs are one of the systemic treatments being used. As a side effect, they can cause a form of hepatitis manifested by elevations of the blood liver enzymes. Methodology: A cross-section study of a total of fifty patients with severe chronic plaque psoriasis were treated with the biologic anti-TNF inhibitor agent, Etanercept, and followed up for twenty four months by regular blood liver enzymes estimations Results:Fourteen patients (28%) showed increased enzymes levels, of them five patients (10%) showed elevated alanine aminotransferase and/ or aspartate aminotransferase levels, six patients (12%) showed elevated alkaline phosphatase, and three patients (6%) showed elevated levels of the three enzymes at the same time. It was reported that almost all of them showed an acceptable amount of elevations which were less than two folds of the upper normal level and only two patients (4%) exceeded two folds of the upper normal level. Conclusion: The overall frequency of elevations in blood liver enzymes in our patients was 14 (28%) collectively.The range was from 6-12% according to the type of the enzyme. The onset of blood liver enzyme elevations was from 3 to 24 months after starting the medication.